Torture Medico legal aspect

Article 3 of Universal Declaration of Human Rights states “everyone has
the right to life, liberty and security of a person”

Article 21 of the Constitution of India guarantees no person shall be
deprived of his life or personal liberty except according to the procedure
established by law”

Thus right to life, liberty and security of a person are recognized as a
fundamental right by the Universal Declaration of Human Right (article
3 of 1948 and article 21 of the Indian Constitution

1. TORTURE Dr Faiz Ahmad

2. INTRODUCTION Article 3 of Universal Declaration of Human Rights states “everyone has the right to life, liberty and security of a person”. Article 21 of the Constitution of India guarantees “ no person shall be deprived of his life or personal liberty except according to the procedure established by law”. Thus right to life, liberty and security of a person are recognized as a fundamental right by the Universal Declaration of Human Right (article 3) of 1948 and article 21 of the Indian Constitution.

3. DEFINITIONS Torture (Latin tortus , to twist) is infliction of intense pain (e.g. from burning, crushing, wounding etc ) to punish, coerce, or afford sadistic pleasure . The Webster dictionary defines torture as ‘ anguish of body or mind, something that causes agony or pain , to punish, coerce or afford sadistic pleasure.

4. In 1975, World Medical Association adopted a declaration called Declaration of Tokyo that defined torture as, ‘A deliberate, systemic or wanton infliction of physical or mental suffering by one or more persons acting alone or on the orders of any authority to force another person to yield information, to make a confession or for any other reason.

5. Who are the victims?   Anyone children as well as adults, young as well as old, religious as well as atheists, intellectuals and the uneducated alike.  Victims of torture do not suffer alone. Victims' families and friends are also greatly affected. 

6. Who are the perpetrators?   Those most likely to be involved in torture include persons such as: P rison officers/detention staff The police The military P aramilitary forces But perpetrators may also include: H ealth professionals L egal professionals

7. Reasons for Torture To obtain information To force confession To obtain statement incriminating others To spread terror in society To destroy personality To take revenge

8. Classification of Torture That done on the person by his consent. That done by others (without consent) that can be further sub classified as that committed on an innocent person or on a person who is not innocent (criminals or terrorists).

9. Types of Torture Physical torture Psychological torture Sexual torture Pharmacological

10. Physical torture : Here the method of torture involves infliction of pain, suffering, discomfort or dysfunction of body. The methods are: Beating Application of heat/cold Electrical torture Pulling and/or twisting of nails/hairs/tongue/teeth/breast/ genitals Suspension Mutilation Forced labour

11. Beating Commonest form of torture B lunt instruments like belt, bicycle chains , lathi , metal or wooden bar, whip etc. Target and injuries produced Back [Most common] - abrasions, contusions, lacerations are produced Abdomen – rupture of viscera may occur Head – head injury, skull fractures, intracranial hemorrhages. Detection In the living - via ultrasound ( b) In the dead- Bruising in the back is not seen superficially because of thick fascial planes. Deep dissection is necessary to reveal bruising. Aseptic necrosis may be seen.

12. Chepuwa A Bhutanese torture technique. Both thighs or legs are tightly clamped with bamboo for a number of days. The two sides of the clamps are pressed with torturer’s legs or he may stand on the 2 sides of the clamps.

13. Electric torture - Also called cattle prod . Picana (a ) victim is strapped to a wooden table and wetted to aid the flow of current. ( b) Current [DC, usually powered by an automobile battery] is applied to sensitive parts of the body eg head, temples, eyes, mouth, teeth, tongue , breasts, nipples and genitalia (c ) A doctor is present to make sure that the victim has no heart problems and can survive the interrogation (d) May result in the loss or fracture of teeth. La parrilla (metal grill) Electric shocks given while the victim is tied to a metal bed frame.

14. Falanga [ A lso known as bastinado, falaka , falaqa , foot whipping and phalanga ] Beating of the soles of the feet with canes or rods. Extremely painful and debilitating (there is clustering of nerve endings in the feet) Foot being weight bearing organ, injuries take long time to heal L eaves few physical marks Detection –Dissection of soles may be necessary.

15. Force Feeding – of boiling water, mustard oil, pepper, saturated salt water, vinegar, urine and feces etc. Knee capping - Victim is shot through the knee joint. Common in Northern Ireland. Telefono Telefono is hard slapping to one or both ears causing rapid increase in pressure in the ear canal  potentially rupturing the eardrum.

16. Forced standing Types standing on both feet On one foot [could be in hot sun to increase pain] Called Planton in Latin America and stoika in the Soviet Union. An attractive option for torturers because like water torture, it leaves no marks Effects ( a) Swelling of the ankles and feet to twice their size within 24 hours (b) Moving becomes agonizing ( c) Development of large blisters (d)Increasing of the heart rate and fainting.

17. Submarino Dry submarino ( submarino seco )- Near suffocation by pulling a plastic bag (usually a shopping bag sometimes containing chillies and/or petrol) over the head and face. Wet submarino ( submarino mojado )- Face of the victim is forced under water usually contaminated with excrement, urine, vomit or blood. Victim may die of drowning. Feces ( or other extraneous material) in lungs at autopsy.

18. Waterboarding  Is a form of water torture in which water is poured over a cloth covering the face and breathing passages of an immobilized captive, causing the person to experience the sensation of  drowning. W ater is poured intermittently to prevent death. If the water is poured uninterruptedly it will lead to death by asphyxia, also called dry drowning. Adverse physical effects can last for months, and psychological effects for years

19. Water cure   Is a form of torture in which the victim is forced to drink large quantities of water in a short time, resulting in gastric distension, water intoxication, and possibly  death.

20. Stress position Also known as a  submission position , places the human body in such a way that a great amount of weight is placed on just one or two muscles. Forced to stand on the balls of his feet, Squat so that his thighs are parallel to the ground. This creates an intense amount of pressure on the legs, leading first to pain and then muscle failure.

21. Strappado Also known as  corda , is a form of  torture wherein the victim's hands are tied behind his or her back and suspended by a rope attached to the wrists, typically resulting in dislocated shoulders. Weights may be added to the body to intensify the effect and increase the pain. Scalping  is the act of cutting or tearing a part of the human scalp, with hair attached, from the head.

22. Psychological torture The methods are: 1. Deprivation techniques and involves Social deprivation Perceptual deprivation Sensory deprivation Sleep deprivation Nutritional deprivation Hygienic deprivation Health services deprivation 2. Coercion techniques 3. Communication techniques

23. Blindfolding Deprivation techniques Deprivation of sleep by use of continuous highpitched sound. Deprivation of the use of toilet, clean habitable place, isolated captivity [social deprivation] Mock execution - Victim is deliberately but falsely made to feel that his execution or that of another person is imminent .

24. Providing false information to victim – e.g. tragedy involving wife and children C onfinement - in a dark place Threat of permanent, severe disfigurement to victim or his loved ones [ e.g. wife , children] Witness torture – Victim is forced to witness the torture of another person.

25. Sexual Torture It includes : Undress or paraded naked or photographed in humiliating position (usually in women) Sexual assault like rape/gang rape, fellatio or forced masturbation , sodomy (usually in males) Forced abortion Pinching or biting off of nipples Electric baton shock of nipples and vagina Inserting bottles and rods inside the vagina Psychological assault, like forced nakedness H umiliation or forced witness of sexual torture

26. Pharmacological Torture It uses psychotropic and/or other chemicals to induce pain and cause compliance with the torturer's goals. It includes forced ingestion or injection of psychotropic drugs (e.g. dimenhydrinate ) or being forced to ingest (or be injected with) chemicals or other products (such as broken glass, heated water or soaps) that cause pain and internal damage.

27. Consequences or Complications of Torture Physical Complications Early 1. Injuries 2. Hemorrhage 3. Infections Delayed 1. Scars 2. Mutilations 3. Malunion of bones 4. Disfiguration 5. Impairment of vision/hearing/joint

28. Psychological Complications 1. Depression 2. Sleep disturbances 3. Low self esteem 4. Stress disorder

29. Torture and Medical Ethics Freedom from torture is among the human rights contained in the United Nations’ Universal Declaration of Human Rights. Violation of human rights by Registered Medical Practitioner (RMP) is an unethical act. The Physician shall not aid or abet torture nor shall he be a party to either infliction of mental or physical trauma or concealment of torture inflicted by some other person or agency and doing such thing is clear violation of human rights .

30. Doctors are obliged by Hippocratic Oath not to use their professional knowledge in order to harm their patients. Geneva Declaration of the WMA binds the doctor with the words “the health of my patient will be my first consideration ”.

31. Tokyo Declaration adopted by World Medical Association (WMA ) in 1975 states that. A doctor shall not countenance, condone or participate in the practice of torture or other forms of cruel, inhuman or degrading procedures . A doctor shall not provide any premises, instruments, substances , or knowledge to facilitate the practice of torture .

32. The World Medical Association will support and encourage the international community, the national medical associations and fellow professional colleagues, to support a doctor and his family, in the face of threats or reprisal resulting from refusal to condone the use of torture or other forms of cruel, inhuman , or degrading treatment.

33. The declaration of Hamburg of WMA prohibited the medical doctors throughout the world from countenancing, condoning or participating in practice of torture or other forms of cruel, inhuman or degrading procedures for any reason.

34. Legal Aspects Section 330 and 331 of IPC deals with the crime and punishment of voluntarily causing hurt or grievous hurt for the purpose of extorting confession or any information. In India, the protection of Human Rights Act 1993 was enacted for protection of human rights. The Act provides for the constitution of a National Human Rights Commission, State Human Rights Commission in states and Human Rights Courts for protection of human rights and for matters connected there with or incidental there to .

35. Involvement of Doctors in Torture Doctors may some time be involved in infliction of torture by the State or authorities. Doctor may help torture in following ways (Doctor should not help in such procedure) Assessing torture technique Training others in technique Assessing detainees’ fitness Provide methods for torture

36. The following are some of the steps taken to prevent torture 1. To abolish torture a campaign amongst the medical community against torture must be devised and how it is contrary to medical ethics . 2. Doctors should document evidence of torture and conduct autopsies in a fair manner and help the victims to obtain redress. It is the ethical obligation of all doctors to report cases of torture .

37. 3. The medical association should issue official directive condemning and banning these practices and prescribe strict ethical rules and guidelines in this regard and strict measures should be taken for their violation 4. The law should be amended so that every accused person, on arrest should be medically examined and injuries of any onhis person should be entered in to the record.

38. 5 . Training about torture, its consequences, treatment and rehabilitation of torture victims and medical ethics should form part of the medical curriculum especially at the undergraduate level. 6 . Doctors involved in the cover-up operations should be made personally liable and preceded against section 166 of I.P.C. . The responsibility of filing such charges should be taken up by the Indian Medical Association . 7. State medical councils should be properly activated to enforce ethics within the profession .

39. THANKS